Uses multiple fixed beams of constant shape to treat a region of the body while blocking out dose to surrounding tissues.

Intensity-Modulated Radiation Therapy (IMRT)

Using sophisticated computer-controlled movements of the treatment machine, a radiation dose is "painted” on a target within the body while minimizing dose to adjacent tissues. Multiple fixed positions of the treatment machine are used, and treatment times vary.

Volumetric-Modulated Arc Therapy (VMAT/RapidArc)

Similar in scope to IMRT treatments (see above) but the "painting” of the dose occurs as the machine is constantly rotating through one or more arcs around the body. This usually results in faster treatment times than a more traditional IMRT plan.

Used to deliver high doses of radiation precisely to targets within the body, usually in three to five treatment sessions. Most often used for lung, spine, prostate, isolated liver and adrenal tumors.

Stereotactic Radiosurgery (SRS)

Typically a single very high dose of precisely aimed radiation to targets within the brain.

ElectronTherapy

Used to treat superficial locations (eg: skin cancers, some breast cancers) by utilizing some of the physical properties of these particles.

Unsealed Sources

Via Olympic Medical Center in Port Angeles, we also offer "unsealed source” therapy, such as Radium (aka "Xofigo”) for metastatic prostate cancer, and Samarium for bone pain relief from a wider range of metastatic tumors.

All treatments are performed using a sophisticated machine called a linear accelerator (LINAC) which generates x-rays or electrons of a specific high energy, in the form of a beam that is then carefully shaped and aimed at target regions. On-board imaging (OBI) enables the treatment machine to acquire images of a treatment site in the body prior to and during radiation treatments to ensure the target and normal tissues are well positioned. The LINAC can take x-ray images as well as low dose "cone beam” CT scans for 3-dimensional anatomy visualization, and those images are used to refine the daily alignment and ensure accuracy.

In addition to the above, certain additional capabilities that may be used to further improve treatments include:

Deep-Inspiration Breath-Hold (DIBH) treatments are used to help limit, even further, small doses to the heart tissue for left-sided breast cancer treatments, or to patients with lymphomas occurring in the center of the chest.

The advanced-imaging capability enables the treatment machine and treating staff to track implanted markers in real-time during each radiation treatment. This is most commonly utilized during prostate cancer and some lung cancer radiation treatments where there can be significant movement of the targets during treatment delivery. Other specialists (eg: urologists, pulmonologists, surgeons) typically implant those markers prior to radiation therapy.

A 6-degree-of-freedom "couch” allows both very fine-tuned rotational (pitch/roll/yaw) and translational (up-down/left-right/top-bottom) adjustments to be made on a daily basis before treatments to ensure precision alignment.

In addition, we consult and coordinate with other clinics that may provide other specialized procedures such as low dose rate (LDR) brachytherapy, high dose rate (HDR) therapy, proton/particle therapy, etc if these are needed for comprehensive cancer care.

What does my first visit to radiation oncology and subsequent appointments look like?

On your first visit/consultation, you will meet with your care team (nurse and/or medical assistant, physician), have an exam, talk about your cancer (or other reason for treatment), and discuss what treatment options you might have including any non-radiation options if appropriate. Together we will review the benefits and risks of any proposed therapy, and your questions will be answered as well as possible. This is like most of the other clinic experiences you may have had, and therapy (except in unusual cases) does not start on the same day.

If radiation will be used in your care, a planning session (simulation) is scheduled. That visit usually takes 30-60 minutes depending on the complexity of the radiation setup. You will meet some of the radiation therapists who will be involved in physically setting you up for later treatments. This is just the planning step, and the goal is to create "molds” such as masks or "cradles” that can help put your body and its parts in exactly the same position for all of your treatments. A short CT scan is performed to allow your team to create your actual individualized treatment plans using sophisticated software. (This is performed after you have left.)

Treatment starts at some point after the simulation, planning and safety-checking is completed. In unusual cases, this is the same day or the next day, but for non-emergency problems there is usually a starting date coordinated with you which is both timely and compatible with the other commitments in your life. If you will also be receiving chemotherapy at the same time (per your medical oncology team) then this timing is also coordinated. Patients usually have radiation treatment at the same time every weekday until/unless they choose a different time or they complete all of the planned treatments. Actual treatments may be as short as 10-15 minutes each day but some kinds of treatments may be longer.

Some patients may be referred to other medical specialists to coordinate other aspects of care, and to other services depending on the assessment of support and functional needs. Examples include nutrition/dietitian services, physical and occupational therapy, lymphedema therapy and home health.

At least once a week during treatment you will meet again with your care team including the nurse, medical assistant, physician, and review any symptoms or problems that are developing. While no one "feels” the radiation itself, some side effects slowly build up over time depending on the part(s) of the body being treated. Suggestions to manage any problems will be made.

After treatment is completed, a follow-up appointment to check up on your recovery progress and manage any ongoing symptoms is made. Depending on what symptoms you may have or the severity of those symptoms, you may be asked to come back in a week or six weeks, for example.

Your radiation oncology team typically stays involved in your cancer care follow-up to help interpret imaging scans, evaluate physical symptoms, monitor for potential side effects that may only appear several months or longer after treatment is completed, and contribute to your screening and overall lifestyle/survivorship recommendations.